Provider Demographics
NPI:1972992139
Name:LIFE THERAPEUTIC WORKS LLC
Entity Type:Organization
Organization Name:LIFE THERAPEUTIC WORKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOELLE
Authorized Official - Middle Name:SUSANN
Authorized Official - Last Name:SEAUNIER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:360-789-9555
Mailing Address - Street 1:3801 S BAY LOOP NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-2648
Mailing Address - Country:US
Mailing Address - Phone:360-789-9555
Mailing Address - Fax:360-628-8849
Practice Address - Street 1:3801 S BAY LOOP NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-2648
Practice Address - Country:US
Practice Address - Phone:360-789-9555
Practice Address - Fax:360-628-8849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60184902251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health